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Aggressive and acute periodontal diseases.
[papillon-lefèvre syndrome]
Inflammatory
periodontal
diseases
are
highly
prevalent
,
although
most
of
these
diseases
develop
and
progress
slowly
,
often
unnoticed
by
the
affected
individual
.
However
,
a
subgroup
of
these
diseases
include
aggressive
and
acute
forms
that
have
a
relatively
low
prevalence
but
show
a
rapid-course
,
high
rate
of
progression
leading
to
severe
destruction
of
the
periodontal
tissues
,
or
cause
systemic
symptoms
that
often
require
urgent
attention
from
healthcare
providers
.
Aggressive
periodontitis
is
an
early
-onset
,
destructive
disease
that
shows
a
high
rate
of
periodontal
progression
and
distinctive
clinical
features
.
A
contemporary
case
definition
of
this
disease
is
presented
.
Population
studies
show
that
the
disease
is
more
prevalent
in
certain
geographic
regions
and
ethnic
groups
.
Aggressive
periodontitis
is
an
infectious
disease
,
and
recent
data
show
that
in
affected
subjects
the
subgingival
microbiota
is
composed
of
a
mixed
microbial
infection
,
with
a
wide
heterogeneity
in
the
types
and
proportions
of
microorganisms
recovered
.
Furthermore
,
there
are
significant
differences
in
the
microbiota
of
the
disease
among
different
geographic
regions
and
ethnicities
.
There
is
also
evidence
that
the
Aggregatibacter
actinomycetemycomitans-
JP
2
clone
may
play
an
important
role
in
the
development
of
the
disease
in
certain
populations
.
The
host
response
plays
an
important
role
in
the
susceptibility
to
aggressive
periodontitis
,
where
the
immune
response
may
be
complex
and
involve
multiple
mechanisms
.
Also
,
genetic
factors
seem
to
play
an
important
role
in
the
pathogenesis
of
this
disease
,
but
the
mechanisms
of
increased
susceptibility
are
complex
and
not
yet
fully
understood
.
The
available
data
suggest
that
aggressive
periodontitis
is
caused
by
mutations
either
in
a
few
major
genes
or
in
multiple
small
-effect
genes
,
and
there
is
also
evidence
of
gene
-
gene
and
gene
-environment
interaction
effects
.
Diagnostic
methods
for
this
disease
,
based
on
a
specific
microbiologic
,
immunologic
or
genetic
profile
,
currently
do
not
exist
.
Genetic
markers
have
the
potential
to
be
implemented
as
screening
tools
to
identify
subjects
at
risk
.
This
approach
may
significantly
enhance
treatment
outcome
through
the
early
detection
and
treatment
of
affected
subjects
,
as
well
as
using
future
approaches
based
on
gene
therapy
.
At
present
,
the
treatment
of
this
disease
is
directed
toward
elimination
of
the
subgingival
bacterial
load
and
other
local
risk
factors
.
Adjunctive
use
of
appropriate
systemic
antibiotics
is
recommended
and
may
contribute
to
a
longer
suppression
of
the
microbial
infection
.
Other
aggressive
forms
of
periodontal
diseases
occur
in
patients
who
are
affected
with
certain
systemic
diseases
,
including
the
leukocyte
adhesion
deficiency
syndrome
,
Papillon-
Lefèvre
syndrome
,
Chediak-
Higashi
syndrome
and
Down
syndrome
.
Management
of
the
periodontal
component
of
these
diseases
is
very
challenging
.
Acute
gingival
and
periodontal
lesions
include
a
group
of
disorders
that
range
from
nondestructive
to
destructive
forms
,
and
these
lesions
are
usually
associated
with
pain
and
are
a
common
reason
for
emergency
dental
consultations
.
Some
of
these
lesions
may
cause
a
rapid
and
severe
destruction
of
the
periodontal
tissues
and
loss
of
teeth
.
Oral
infections
,
particularly
acute
infections
,
can
spread
to
extra
-
oral
sites
and
cause
serious
medical
complications
,
and
even
death
.
Hence
,
prompt
diagnosis
and
treatment
are
paramount
.
Diseases
Validation
Diseases presenting
"with a wide heterogeneity in the types and proportions of microorganisms recovered"
symptom
papillon-lefèvre syndrome
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